Ipsilateral femoral neck and shaft fractures

Ipsilateral femoral neck and shaft fractures occur in 2.5% to 6% of femur fractures. The injury results from high energy trauma. Victims are usually young, with multiple associated injuries. The diagnosis of the neck fracture is delayed in 19% to 31% of patients. The neck fracture line is almost vertical and nondisplaced, or minimally displaced in 26% to 59% of cases. The shaft fracture is often midshaft and open, and/or comminuted in 47% to 67% of cases. Ipsilateral knee injuries occur in 20% to 40% of patients. Two major complications, osteonecrosis of the femoral head and nonunion of the neck, result from the neck fracture. Therefore, treatment of the neck fracture takes precedence. The rate of osteonecrosis is unknown, but probably is in the range of 4% to 22%. Union rate of the neck is high and related to stable, anatomic reduction. The timing of operative fixation often is dictated by the patient's status as a multiple trauma victim, but a delay of days to weeks in the fixation of the neck fracture does not seem to increase the complication rate. The goal of any treatment plan should be anatomic reduction of the neck fracture, and stable fixation of both fractures, so that the patient can be mobilized.